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Preventing Childhood Obesity

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Preventing Childhood Obesity Starting Early: The Baby Milk Trial Raj Lakshman MRC Epidemiology Unit 24th January 2012 – PowerPoint PPT presentation

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Title: Preventing Childhood Obesity


1
Preventing Childhood Obesity Starting Early The
Baby Milk Trial Raj Lakshman MRC Epidemiology
Unit 24th January 2012
2
Outline
  • Infant feeding in obesity prevention
  • The Baby Milk Trial
  • Rationale
  • Development
  • Design
  • Outcomes
  • Policy implications

3
Why infant feeding is important?
  • Over 1 in 5 children overweight (13) or obese
    (10) NCMP 2009/10
  • Early intervention is a National priority
    Foresight, HWHL
  • Evidence of programming
  • Appetite
  • Flavour
  • Metabolic

4
6 kg in 1st year
5
Distance between 2 lines 0.67SDS
6
2 fold higher risk
Druet et al 2011 Paediatric and Perinatal
Epidemiology
7
(No Transcript)
8
Fat mass at 17yrs
Crossing 1 centile line (0.67 SDS) from 0-6 mo
Ekelund et al 2006 AJCN Leunissen et al 2009 JAMA
9
40 in first weeks
FAO/WHO/UNU 2005, SACN 2011
10
FAO/WHO/UNU 2005
11
Weight SDS
Age in years
Ong et al 2002 Paediatric Research
12
Breast feeding statistics (UK)
81 start BUT by 6 weeks only 21 exclusively
breastfeeding
13
How we designed the intervention and evaluation
  • Determinants
  • Systematic Reviews
  • Qualitative studies
  • Questionnaires
  • Multi-disciplinary team

Campbell et al 2007 BMJ Framework for complex
interventions
14
JADA 2010
  • Aim to understand determinants of
    non-recommended feeding practices
  • 78 studies, 48 determinants
  • Early Weaning- young maternal age, low education,
    low SES, smoking, short breastfeeding, lack of
    information and advice from Healthcare providers

15
  • Aim how parents decide on how much and how often
    to feed their babies?
  • 23 studies
  • No literature on this
  • Inadequate information and support
  • Negative emotions- guilt, worry, sense of failure
  • Mistakes in feed preparation
  • Frequent formula-feed changes

16
(No Transcript)
17
In Press Lakshman R, Landsbaugh J, Schiff A,
Cohn C, Griffin S, Ong KK
  • Interviews, Focus groups
  • Mothers, Healthcare providers
  • I had no advice on bottle feeding and he was
    crying so much that I was feeding him every ten
    minutes..
  • He drank for six and a half hours and he was
    swallowing for six and a half hours. He would
    drink about two and a half bottles. ..sometimes
    hed have nine bottles a day.

18
IJBNPA 2011
  • 57-item questionnaire
  • Energy intake
  • Maternal attitudes
  • Face validity, Criterion validity, Test-retest
    reliability
  • Almost half the mothers who prepared formula-milk
    from powder, tightly packed the scoops

19
What is the Baby Milk intervention?
  • Optimise energy intake
  • Infant satiety cues
  • Non-hunger related fussiness
  • Feedback on growth
  • Rapid weight gain
  • Weaning

20
The components of the Baby Milk intervention
21
Baby Milk Trial
  • Explanatory RCT to examine efficacy of the Baby
    Milk intervention
  • Primary Outcome change in weight sds from
    birth-1yr
  • Trial and cohort analyses

22
700 Mothers who start formula feeds within 14
weeks of birth
Baseline visit at 2-14weeks
2 mo
2 mo
Intervention group
Control group
3 mo
3 mo
4 mo
Behavioural intervention
Standard advice
4 mo
5 mo
5 mo
Babys age 6-7 months-End of intervention
6 mo
6 mo
Babys age 8 months- 4 Day-Diet Diary
Babys age 12 months-Outcome measurements
23
Evaluation Causal modelling
Behavioural Determinants
Attitudes, beliefs, intentions, self-efficacy,
outcome-expectancy- Questionnaires at baseline
and 6-months
Milk feeding questionnaire at baseline, 3,4, 5,
6 months, Diet diary at 8 months
Behaviour
Socio-economic, cultural, antenatal and genetic
factors
Anthropometry at baseline, 6 and 12 months, USS
and skin-folds at 12 months
Growth
Health/Disease Outcomes
Modelling long term outcomes, cost-effectiveness
analyses, long term follow-up
24
Study Measures
Baseline
Questionnaire measures
Pregnancy, Demography, Lifestyle etc I,C
Milk feeds (also at 3,4,5 mo) I,C
Feeding and maternal attitudes I,C
Temperament, sleep, eating behaviour I,C
4-day diet diary
Health service utilisation
Maternal QoL I,C
Intervention evaluation
Anthropometry
Parents anthropometry I,C
Babys anthropometry I,C
6 mo


I,C
I,C
I,C

I,C
I,C
I

I,C
I,C
8 mo





I,C






12 mo






I,C
I,C
I

I,C
I,C
I- Intervention, C- Control group
25
Policy implications
  • Inform future infant feeding guidelines
  • Health Visitor practice and Healthy Child
    Programme
  • NPRI Scientific Committee
  • A powerful intervention that has potential
    to provide
  • valuable evidence in an important and
    changing policy
  • environment

26
Thank You
CEDAR support Rebecca Strafford Research
Manager, CEDAR Annie Schiff Study Co-ordinator,
CEDAR Alvaro Ullrich Data Manager,
CEDAR Intervention Facilitators Paediatric
Research Nurses, University of Cambridge MRC
Epidemiology Unit support James
Sylvester Research Manager, MRC Measurement
Team Research Assistants, MRC Investigators Ken
Ong Programme Leader, MRC Simon
Griffin Assistant Director, MRC Wendy
Hardeman Senior Research Associate, IPH Simon
Cohn Senior Lecturer, IPH Marc Suhrcke Prof
Health Economics, UEA Ed Wilson Lecturer Health
Economics, UEA Collaborators David
Vickers Medical Director, CCS NHS Trust Alison
Lennox Principal Investigator Scientist, MRC
HNR

27
ACKNOWLEDGEMENT This work was undertaken by the
Centre for Diet and Activity Research (CEDAR), a
UKCRC Public Health Research Centre of
Excellence. Funding from the British Heart
Foundation, Economic and Social Research Council,
Medical Research Council, the National Institute
for Health Research, and the Wellcome Trust,
under the auspices of the UK Clinical Research
Collaboration, is gratefully acknowledged.
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